When we experience trauma, our brains don’t function like they normally do. We go into survival mode: think fight, flight, or freeze. Our brains automatically direct all of our energy toward dealing with this immediate threat until it’s gone. In most situations, this feeling of being in danger fades over time. Maybe it takes a few hours or a few days but you eventually start to feel better and less on edge.

But sometimes that initial trauma sticks, and you just can’t seem to shake the feeling that you’re still in survival mode. Trauma can change the way we think, act, and feel for a long time after the initial event occurred. Things like flashbacks or nightmares, constantly feeling on edge, anger, intrusive thoughts, and self-destructive behaviors are all very normal responses to trauma. You might feel as if you’re stuck living with these symptoms for the rest of your life, but the good news is these patterns can actually be reversed. With the right approach and knowledge, you can shift your brain towards overcoming past trauma and begin your healing journey.

The Brain's Response to Trauma

Trauma’s impact on the brain is complex. Let’s talk science for a minute to review some parts of the brain. Trust me, I’m not a fan of science either. But I promise this is helpful to know in terms of healing, so stick with me.

To simplify things, let’s break it down into two parts: the subconscious system vs. the conscious system. Do those terms sound familiar? Your subconscious mind is responsible for any involuntary actions, and your conscious mind is responsible for rationalizing and logical thinking.

Okay, let’s take this one step further. The subconscious part of your brain involves the Limbic System (think automatic) and the conscious part of your brain involves the Frontal Lobe (think choice). Both of these systems work together to help you survive and stay safe. If you’re in trouble, the frontal lobe says, ‘yes, this is dangerous’ and allows the limbic system to react in either a fight, flight or freeze response. On the other hand, if your frontal lobe realizes you are not in any danger, it works to calm down the limbic system’s reaction.

You might be asking why this is relevant. Well, here’s why. Trauma can disrupt the ability of your limbic system and frontal lobe to work together, and this causes you to either go numb or into overdrive.

When we talk about feeling ‘triggered’ in terms of trauma, we are referring to the subconscious response. The limbic system becomes extra sensitive to our triggers (sights, sounds, smells, feelings, etc.). And even though you aren’t in any current danger, the limbic system overreacts and overwhelms the frontal lobe by triggering survival mode. As a result, your frontal lobe either undercompensates or overcompensates (cue feelings of numbness or going into overdrive). You do not know how to move forward and stay safe at the same time. 

There are many different ways these two parts of the brain work together when we talk about trauma and healing. Everyone’s experience is different, but many of the changes we see in the brain are similar. Here’s one common example.

Jane is out shopping and passes someone in the store who is wearing cologne. The smell of that cologne reminds her limbic system of her past trauma, and the limbic system now believes Jane is in danger. Jane feels her heart race, her mind starts spinning, and she feels like she wants to run away to be anywhere but here. 

This is a completely normal reaction for Jane’s body and brain to have to a potential threat, even though she wasn’t in any danger. It’s an automatic reaction. And that’s not necessarily a bad thing. In the past, the smell of cologne was associated with a threat, so the brain triggered a response thinking it had to do something to keep Jane safe. If you think about it, your brain is doing exactly what it should be doing. It’s just still thinking the smell of that cologne means danger, even though Jane knows otherwise.

You might be thinking, ‘great, so I’m stuck like this?” In short, no you’re not! It is possible to help your frontal lobe and limbic system heal and work together more efficiently. 

Healing the Brain

You may have heard the term neuroplasticity before. This simply means our brains are able to modify, adapt, and change throughout life. Some things changed in your brain when you experienced trauma, and we can appreciate that as it was necessary for survival at the time. But now that that experience is behind you, you probably want to leave it there and stop feeling such strong emotions at simple reminders. And I don’t blame you! The good news is, that is very possible. Maybe your triggers are similar to Jane’s triggers, or maybe it’s completely different for you. Either way, it is possible to rewire and retrain your brain again.

So, where do you begin? For starters, it’s always a good idea to process any past trauma in therapy. If you haven’t already, find yourself a trusted therapist to support you through your healing journey. 

The next step here is really going to be identifying where you’re having difficulty. Is it similar to Jane’s experience where you see or smell something that triggers you? Or maybe your past experiences are affecting your ability to focus, make decisions, and resist impulses. These are all things that can be worked on and improved with practice. 

During the healing process, your brain can create new pathways, increase function in some areas (like your frontal lobe!!) and strengthen connections. There are many different ways you can work on improving brain function. I’m sure you’ve heard of ‘brain games’ before, right? They’re basically games that stimulate your mind and help you practice certain cognitive functions like memory, problem solving, or critical thinking. 

There are similar exercises you can do on a daily basis that will be ‘training’ one or more parts of your brain. Here’s one example. We’ll call this exercise ‘Planning Ahead’.

Is there something you want or need to get done this week? Picking a day or time to sit down and accomplish that task can help to actually push yourself to do it, but it’s also a really simple exercise for your brain. When you write down even one reminder of what you want to focus on, you’re strengthening the connection between your limbic system and frontal lobe.

You can practice this by using the calendar or reminder app in your phone, or print out a good old-fashioned calendar from google. Maybe start by penciling in any appointments you have, and scheduling some of your household chores around them. Or maybe you want to schedule some time to sit down and read a book. Whatever it is, make a plan to do it, and follow through with that plan.

When you make conscious choices by planning, tracking, and following through, you’re strengthening your frontal lobe. This added strength builds new connections in your brain and creates positive experiences for you to look back on and feel proud of. 

With time and practice, these connections will get stronger and you’ll continue to feel empowered to act on your plans and dreams. And if those plans and dreams include overcoming your past trauma, you’ll feel empowered to take continued steps towards healing. 

If you’re interested in learning more about how to reverse the impacts of trauma, I’m facilitating a group called Finding Hope for women survivors of childhood sexual abuse this fall. Visit our website or call (631) 503-1539 for more information!

-Jennifer Tietjen, LMSW

Art therapy is a newer form of therapy. It is an integrative mental health practice that is designed to improve the lives of individuals, families, and communities through the process of art-making, creative process, applied psychological theory, and human experience within a therapeutic relationship.

Art therapy should be done by a trained professional of art therapy. This will improve the  effectiveness as art therapists are trained to create art therapy exercises that are designed to not only support you but also to help move deeper into your therapeutic goal.  Art therapists are trained to use their knowledge to support your personal and therapeutic treatment goals throughout treatment. Art therapy has been used to improve cognitive and  sensorimotor functions, help support a better relationship with self-esteem and self-awareness, produce emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and distress.

Art therapy is a wonderful tool therapists use to help patients interpret, express, and resolve their emotions and thoughts. This is a newer type of therapy and was first established in the 1940s however the practice did not become more widespread till the 1970s. Like other expressive arts therapy, such as dance therapy or music therapy, it draws on creativity.

Inaccurate Use of Term 'Art Therapy'

Often people mistake  “Art therapy” for things that are not necessarily due  to a lack of knowledge about the profession. However these situations provide an opportunity to offer accurate information and educate the public. This modality must be done by a trained art therapist or it is technically not art therapy. Some products that are mistaken for art therapy are adult coloring books and paint by numbers. Art therapists are not art teachers, their goal is not to make you a better artist but to help you improve your mental state through the use of art.

How Art Therapy Works

Many people ask "What is art therapy and how does it work?" It is all about  expression. The process of creating is the most important thing, not the end product which is why anyone can do it. Often many people shy away due to a fear of not being an artist but this type of therapy is for anyone. It is designed to use the expressive arts as a way for people to understand and respond to their emotions and thoughts with a valuable new perspective, not only that artistic expression is good for mental health as it is often related to relaxation.

During a session, an art therapist works with clients to understand what is causing them distress. Then the therapist guides the client to create art with an art directive that addresses the cause of their issue or explores it further. During a session, art therapists may:

Through different mediums and art techniques art therapy engages the mind, body, and spirit in ways that are not dependent on verbal articulation alone. Due to the way it engages the body and mind it causes various symbols to be created through the art process, this process also invites modes of receptive and expressive communication, which can benefit those who have limitations of language.

Who are Art Therapists

Art therapists are clinicians who are trained both in traditional clinical therapy and art therapy. Art therapists work with people of all ages and various populations. All art therapists are required to follow an ethical code. All art therapists are also required to have a master’s level education, as well as engage in supervision hours under a trained professional in order to obtain their license. This prepares them for various populations and gives them the ability to perfect their work.

Where Art Therapists Work

Art therapists work with individuals, couples, families, and groups in diverse settings. Some examples include:

Does Art Therapy Work?

There is growing evidence that art therapy helps conditions such as anxiety and depression, trauma, low self-esteem, PTSD, Bipolar  and similar disorders. It has also been used with those facing terminal illnesses such as cancer and those hospitalized experiencing pain, as well as it has been used with people working to develop effective coping skills, including prison inmates

Many clients are reluctant to explore art therapy because they think that they have to have artistic talent for it to work or see it as "arts and crafts" rather than see it as an effective tool. This mindset can be very limiting and can hinder the  effectiveness for these clients. It is important to go in with an open mind.

Is Art Therapy a Good Fit?

There's no way to tell for certain whether art therapy is a good fit for any given person. Therapy is not one-size-fits-all, and a client and therapist may need to use multiple different approaches and techniques in order to find what works best for you. However, if a patient is drawn to art or has had trouble expressing with traditional therapy, art therapy may be a wonderful fit for you.

When choosing a therapist it is good to consider the following. As a potential client, ask about:

Often you should be able to tell in 1-3 sessions if this works for you.

Think Art Therapy Would Benefit You?

If you feel like art may be a good avenue for you to work through your mental health concerns please call our office and ask for Jillian Martino. Jill is our art therapist on staff and would be more than happy to help you work through your concerns through art. Jill specializes in LGBT issues, trauma, children and couples. Contact our office today to set up a free 15 minute consultation.

-Jillian Martino, CAT-LP

Do you have a child who is questioning their own sexual or gender identity? Or are you just curious to learn more about what LGBTQ+ means and how it may impact your child? Whatever the case may be, you ended up here for a reason! Here I will do my best to provide information, advice, support, and maybe you will even get something out of this post that will help you in your life and relationships. We will explore the risks, the coming out process, stereotypes and stigmas regarding the LGBTQ+, as well as some of the things you may experience as parents.

Risks for Your LGBTQ+ Child

It unfortunately goes without saying that children or teens that start expressing their own sexuality or gender, which may be out of the norm, will get weird looks, rude comments, or even just a slight double-take from someone walking by. Therefore, it goes without saying that yes your child may experience some discrimination or bullying from their peers at school or just from random strangers at the supermarket. Here are some quick facts of some of the risks:

However, times are changing and the opinions of others are also changing. As a parent, you want to protect your child from all the different dangers that your child may run into; although that is not always going to be possible!

The Dreadful Process of Coming Out

UGHHH let me tell you, this was one of the hardest things I’ve ever done for myself. And yes, that is correct. I did it for myself. I didn’t do it for the acceptance of others, for others to view me differently, or even just for people to know that one thing about me. I did it for myself because it is something that can be so freeing and such a relief for that kid who’s stayed in the “closet” for so long. As parents, here is my message to you: Your child is absolutely frightened by how you will respond, how you will react, and worst of all if you would still love them for who they really are. There is so much going through their heads that they may not even understand, so for someone with authority like yours, for someone who has been with them since day 0, they are only hoping for support. 

It may be helpful to support your child with their journey to finding out their own identity. As parents, you can be the ones providing the information for your child with the security of it being accurate. There are a few stages to coming out, though primarily the stages of self-discovery, coming out, as well as positive self-identity do have a major impact on the everlasting impact on your child. You can read more about the stages of coming out here: The Stages of Coming Out. 

LGBTQ+ Stereotypes & Myths

What Does it Mean for Your Parents?

As parents who just discovered or found out their child identifies as part of LGBT+, there may be a few different emotions and stages you go through yourself. This is just like any other transition in the family, it is something that is obviously going to cause some shock or take back. Below are some of the stages you may experience as parents, but remember you may not even experience any of these!

There is so much more that can be said within this guide. Always try to be the supportive, kind, gentle parent that you intended to be when your child was born. This Fall, Long Island EMDR will be hosting a support group for parents with LGBT+ youth. Throughout this group, you will be able to garner support from other parents, gain knowledge on LGBT+, as well as learn how to best support your child on their journey. 

-Conor Ohland, MHC-LP

Mindfulness is the ability to be fully present and aware of where we are and what we’re doing. One important aspect of mindfulness is to not be overly reactive or overwhelmed by what’s going on around us or in our mind. It is important to just observe without judgment. Mindfulness is a quality that we can all tap into,  we simply just need to learn to access it. The following prompts are designed to help you begin becoming more mindful in just 15 days!!

1. Write a Gratitude Letter

This is one of my favorite personal practices. Write this letter as if you are writing it to a friend. Write everything you are grateful for as well as everything you are grateful to be working towards. After you do this, read it aloud. I like to do this practice daily. 

2. Meditate

Meditation is a difficult one and can be difficult for people, often we believe that the brain should turn off during meditation. However it is quite the opposite, often our mind will start racing, the buddhist call this monkey brain. It is important during this practice to notice whatever may be coming up for you without engaging or giving the thought energy. After bringing your attention back to your breathing. If this practice is hard for you start small. Start with five minutes and then slowly increase the more you practice. There are also a ton of videos online and apps that can help support you through your meditation.

3. Draw Your Backyard

Take this time to really connect with yourself and your garden. Notice the smells, what you feel in your body. Maybe how your skin feels in the sun etc. Mindfulness is all about giving ourselves a moment to pause and appreciate everything, the good, bad and everything in between. Allow yourself to express without judgment.(If you don’t have a yard pick somewhere in nature) 

4. Mindful Eating

Really make your food an experience here. Just like meditation, focus on every sensation. How does it taste, how does it feel etc. Be present. Thank yourself for the nutrition!

5. Some Areas of My Life I'd Like to Improve Are:

Here is a simple Practice, set your intentions. Setting goals will help us be more mindful of actually making them happen. If you want to add an artistic flare to this exercise, turn this list into a vision board. This is a super fun activity for date night, girls night or just a little self care for you!

6. Declutter Your Space

When decluttering the mind it can be helpful to have our living spaces match this energy. Get rid of all the things making energy shifts in your space, I promise you don’t need those pants that are too small on you that you keep as motivation.  Focus on the now.

7. Some Thoughts and Beliefs I Repeat In My Head Constantly Are:

Good and bad, this is about bringing attention to our critical voice. Be honest with yourself. Remember NO JUDGMENT. 

8. In What Ways Do I Impact Others Around Me Each Day?

Notice your value: if this is hard examine that. Start small if you can only think of two things that’s okay. Continue to revisit this exercise as you move through the practice. I like to make positivity jars for myself where I put little notes of wins I had over a whole year and read them at the end of the year. Sometimes we let the good we do go unnoticed, this time is for you.

9. Create Your Own Mandala

Mandala’s have been known for their meditative properties, they have been recognized by psychologists like Carl Jung for their therapeutic benefits. While creating your mandala again notice what maybe coming up for you.

10. What Are My Biggest Fears and How Do They Hold Me Back?

Again, full transparency here. Want to go even deeper with this exercise? Follow this question up with why do I have these fears? Where did they start?

11. How Can I Better Take Care of Myself?

SELF CARE!!! Do I even need to explain? Not only should you write what you can do for yourself here but also examine what you can do in order to start integrating these things into your day to day.

12. Dance Around in the Mirror

Spirituality states that our hips hold a ton of our trauma. Moving these parts of yourself will help you release some of those big feelings. Pay attention to whatever comes up for you. You may feel awkward or may even feel uncomfortable with seeing your body moving through the mirror. Pay attention to this, bring awareness to it. Meet it with the question why as well as some compassion.

13. Take a Rest Day

Everything needs rest, even you! It is scientifically proven that we are more productive when we rest, this helps us avoid burnout. There is an awesome book called “How to Do Nothing” by Jenny Odell that further explains this.

14. Do Some Yoga

Yoga is a wonderful practice for mindfulness, if its not your thing though do something else to get that blood pumping.This can be walking around your neighborhood or HIIT, whatever makes you feel good! Examine how your body feels before and after your workout.

15. I Feel Fulfilled and Truly Alive When:

Cultivating happiness. Abraham Hicks has a ton of videos speaking of the importance of following our happiness. Happiness is our driving force so lets bring our awareness to it.

Contact us today!

Long Island is celebrated for its iconic white sandy beaches. But did you know we also have some excellent places for a day walk or hike?

As a Nassau resident who grew up on a brook near conservation land in northern New England, I must admit, I had my doubts about falling in love with the scenery across Long Island. But I’ll admit it – Long Island is spectacular in the summertime (I still think New Hampshire is unbeatable for autumn foliage, though, and yes you can debate with me about that one!). As time has passed, I have been happily surprised to find some great day trips across Suffolk and Nassau.

If you are willing to bundle up, consider even doing a beach stroll in the winter! Bring your binoculars. You will be rewarded with waterfowl which have come thousands of miles south from the tundra, including my personal favorite, the exquisite long-tailed duck. You may also see grey and harbor seals!

Here is a list of some of my favorite places to go hiking or walking on Long Island – as well as a few other things, such as horseback-riding!

Places to Walk or Hike in Suffolk County

Sunken Meadow State Park - Smithtown

A familiar favorite located on the Long Island Sound, Sunken Meadow is one of the more accessible parks for people with limited mobility thanks to its long, sturdy boardwalk. It features three miles of beaches, along with six miles of hiking trails. Want to horseback ride? There are bridal paths, too. There is also a golf course.

Sunken Meadow also has softball and soccer fields, along with playgrounds, making it an excellent choice for families who may want to do more than spend their entire day solely on the beach.

Are you curious about foraging? This is one of the locations where the famous forager “Wildman” Steve Brill offers classes. He will show you which plants are edible, which to avoid, and what to do if you contact with poison ivy. I have taken a Wildman class at Sunken Meadow, and it was quite informative!

Long Island Greenbelt Trail – various locations

I will admit it – I have not done the Greenbelt in its entirety. But there is no way I could skip mentioning the ultimate of the Long Island hikes.

The Greenbelt is an impressive 32 miles long, running parallel to the Connetquot and Nissequogue Rivers. The trail varies in terrain, at times being a boardwalk and then changing over to sand. It also has numerous trails with break away from the main one, allowing for this to be a hike or walk that can be experienced many times.

Blydenburgh County Park - Smithtown

Blydenburgh is another popular, family and dog-friendly destination. In addition to scenic views for walks, Blydenburg offers birding, fishing, and horseback riding. Rowboat rentals are available from mid-May to Labor Day.  Finally, tent and RV sites are available for campers from April 1st through November 11th.

The six-mile walk around New Mill Pond is easy for families, and is beautiful in the autumn during peak foliage.

Blydenberg is $7.00 for Suffolk residents and $15 for non-residents.

West Hills County Park – Melville

West Hills is a historical park which reaches Jayne’s Hill, a beloved spot by Walt Whitman and near his birthplace. At 400 feet elevation, this is the highest point on Long Island; it is a 2.4 mile loop considered easy and possible to complete in about 55 minutes. Ideally, this hike is most suitable in the autumn.

Caumsett State Park – Huntington

Caumsett is a large park with various activities. It features an impressive stable and dairy complex, excellent trails for biking, paved trails to walk with a stroller, and even snowshoeing and cross-country skiing trails.

This is also a beautiful park for a walk or hiking, as the wooded areas gradually elevate to be the tops of sand dunes that then look down into the water. As you continue along the trail, you will descend at a seashell-bountiful beach.

Wertheim National Wildlife Refuge – Shirley

Wertheim is one of the few protected, undeveloped estuaries on Long Island. It offers rich biodiversity, perfect for those most interested in seeing wildlife.

Unlike most of the parks and preserves here, Wertheim is not best in the summer or early fall, but rather in late October through early April. This is the time for the most ideal wildlife-viewing, with migratory waterfowl who winter here. Come the early springtime, there will be migratory warblers and other such songbirds. However, all year, you may encounter red fox, white-tailed deer or wild turkey.

Personally, I find Wertheim to be most precious on the water. The placid waters of the Carmans River meander through cattails and reeds, offering a smooth and almost effortless paddle. You are guaranteed to see great wildlife, such as the green heron. Additionally, you may choose to stop at Indian Landing, a small beach where you can take a swim to cool down, or you can continue onto the Great South Bay.

This is my favorite place on all Long Island to launch my paddleboard or kayak. Thanks to being in a refuge, I do not have to deal with wakes or noise. It is also beautiful from the start since to get to the refuge you must go under two bridges, the first being a nesting site for tree swallows.

You can either launch from the free boat launch (although I warn you, the path is muddy and completely unmaintained) or you can use spend $10 to use the dock at Carmans River Canoe & Kayak II. I recommend the later as it is much easier.

Bayard Cutting Arboretum – Great River/Timber Point Park - Oakdale

Bayard Cutting may be the most famous of all the locations I have mentioned, thus, I will not get into detail. Simply put, Bayard Cutting is the place to go if you want to walk and see gorgeous flora – along with Planting Fields in in Oyster Bay.

While I do love Bayard Cutting (who doesn’t?), what draws me there more is not so much the arboretum itself, but rather the picturesque Connetquot River which runs alongside it. In fact, after the Carmans River, this is my other favorite waterway for kayaking and paddleboarding on Long Island.

To paddle -- Drive down to Timer Point Park in Oakdale to launch your water vessel, which you can then paddle toward Bayard Cutting if going left. You can continue beyond Bayard to the many different canals which meander through town. Once you get to around Paradise Island, I recommend you cut straight through the river toward the canal on the other side, rather than continue straight, as this will offer a much longer, quieter, and more interesting experience. Going this way, you will eventually cut through marshland which will eventually lead you out at the canal next to the Snapper Inn. From there, cut straight across the river (be cautious of boats) and you will get right back to the launch.

As an alternative route, you may also go right which will take you to the bay. There is an island where you can relax. However, I do not recommend this route unless you are experienced due to the rapid changes in water conditions and because you will be dealing with wakes caused by jet skis and powerboats.

Places to Walk or Hike in Nassau County

Trail View State Park - Woodbury

The Stillwell Woods Loop, located at Trail View State Park, is a 7-mile loop considered to be of moderate difficulty. It can be completed in around 3 hours. However, what truly sets Trail View apart from other Long Island hiking trails is that it has more range in intensity and elevation – giving it a different feel than the typical flat trails. For the avid hiker, this is one of the few trails where they can truly say “this is a hike, not a walk” and feel challenged.

The park itself skirts Bethpage State Park and Cold Spring Harbor State Park. Thus, you can spend a day (or even two!) hiking and doing other nature-based activities.

Sands Point Preserve – Port Washington

Sands Point is one of the lovelier parks in Nassau County. The Loop is a 2-mile walk that is popular for birders. There are also cliffs overlooking the water, which offers a great opportunity for photographers.

Sands Point also hosts special events, such as yoga.

The price is $4 per person or $10 per car.

Cedar Creek Park – Seaford

Cedar Creek is a 259-acre park best for families and sporting.

Cedar Creek has an excellent playground. It has been voted the best playground across all Long Island in both Long Press and on News 12. Also, a fun activity for the children includes a roller-skating rink.

There are eight handball courts, three basketball courts, and various athletic fields (please note the fields must be reserved and include a Leisure Pass, insurance and permit, and fee). Also of particular interest, there is an archery range open to the public but note you must bring your own equipment.

Additionally, there are paths suitable for walking, jogging, and biking. There are entrances from Cedar Creek to both Tobay Beach and Jones Beach. If you want to get a challenging work-out followed by crisp, relaxing water, consider doing this bike ride!

Massapequa Preserve - Massapequa

Massapequa Preserve spans across an impressive 423 acres. Some parts of the park are frequented by bikers, so do exercise caution if you want to be here for a leisurely walk. However, should you go onto one of the quieter trails, you will quickly be rewarded by various species of deciduous trees as well as some endemic birds. I myself have spotted many different birds here, ranging from various species of warblers to the occasional northern flicker, a unique-looking woodpecker. There is also a popular residential wood duck drake.

Massapequa Preserve is where I offer the majority of my forest therapy sessions. You may read more about that on this blog post: https://liemdr.com/forest-therapy/

Muttontown Preserve – Muttontown

At 550 acres, Muttontown Preserve is by far the largest nature preserve on Long Island. It offers many different ecosystems ranging from upland forests to woodlands to waterways, offering a spectacular opportunity to see different birds, including characteristic species such as the chestnut-sided warbler, indigo bunting, Baltimore oriole, and American woodcock. If you are lucky, you may also spot a great-horned owl or screech owl.

Preparation for Walks and Hikes

Personally, I do not think you will need top-notch gear for almost any Long Island trail… or even gear at all. Disclaimer - I am quite a hiker – I have summited Black Elk Peak in South Dakota, scrambled waterfalls in the Rocky Mountains, traversed the rock fields of Mount Washington, and even backpacked the Alaskan tundra. That said, I do have some impressive gear which has been needed.

But here on Long Island? To be honest, I leave most of my gear at home! For my adventures here, I am fine with a water bottle with a shoulder strap, along with an ultralight daypack. I also pack the following essentials: sunscreen, bug spray, first aid kit, a protein-packed snack, birding binoculars, and my homemade jewelweed salve (for contact with poison ivy). Sometimes I will bring a plant or bird ID guide.

I do recommend appropriate footwear, but hiking boots are overkill unless you need the ankle support. I have a pair of Teva’s which I wore for many years before eventually retiring them. I then bought a pair from LLBean which cost considerably less but seem to be just as durable.

In addition, dress in layers and make sure you have a light raincoat available just in case. Do not wear cotton.

Important Links for Further Information

Camping in Suffolk County
https://www.suffolkcountyny.gov/Departments/Parks/Things-To-Do/Camping/Annual-Group-Lottery

https://web1.myvscloud.com/wbwsc/nysuffolkctywt.wsc/search.html?Module=RN&Type=FamilySite&Display=Detail&_csrf_token=008315ef3e14efdacf115196f3131a26c0a86695beb5eca85408a6b90020e553

Kayaking, Paddleboarding, and Canoeing in Suffolk County
https://www.suffolkcountyny.gov/Departments/Parks/Things-To-Do/Canoeing-and-Kayaking

Horseback-Riding Sites in Suffolk with a Suffolk Green Card and Riding Permit
https://www.suffolkcountyny.gov/Departments/Parks/Things-To-Do/Horseback-Riding

About the author, Valerie Smith, LMSW

Valerie Smith, LMSW, CFTG, is a therapist, social worker, and certified forest therapy guide at Long Island EMDR under the supervision of our clinical director, Jamie Vollmoeller, LCSW. Valerie possesses a bachelor and master's degree in social work from Adelphi University and Fordham University, both from which she graduated summa cum laude. Valerie is also a certified forest therapy guide through the Association of Nature and Forest Therapy (ANFT), where she trained in the Rocky Mountains to master sensory-based, mindful activities through a biophilic perspective. Valerie is passionate about the health benefits of a plant-based diet as well as holistic wellness. Valerie is trained in EMDR and TF-CBT, with experience in DBT-informed skills. She focuses her treatment on adolescent girls and young women with C-PTSD and PTSD. Additionally, she helps people with life-threatening disease and their caregivers. Finally, she works alongside those experiencing grief and bereavement, especially young adults who lost one or both of their parents/guardians.

Throughout Western societies, we buy into the prevalent sociocultural belief of the stage theory of grief. As if to bring comfort and understanding of our loss, we are told we should progress through a series of five stages: denial, anger, bargaining, depression, and acceptance.

Even while I was in graduate school for social work, I can vividly recall some professors ascribing to this model, never once questioning if their claims were accurate since it seems to be a universal statement as true as 2+2=4.

In short, this belief pushes the idea that bereaved individuals must undergo a specific sequence of reactions over time as the result of the death of someone who was significant to them. Not only is this inaccurate since individuals may not experience all the stages in their set order, but it also is stigmatizing to those who never experience the stages at all as they may think there is something “wrong” with them. Thus, I argue that the stage theory should be abandoned, for there are newer, different models that are more accurate for illustrating the grief journey.

On the History of the Five Stages of Grief

In 1969, psychiatrist Elisabeth Kübler-Ross introduced the model in her groundbreaking book On Death and Dying. At the time, there was a severe deficit in medical schools on the topics of death and dying, which motivated Elisabeth Kübler-Ross to do the research herself by observing the reactions of her patients with terminal diseases. She was also influenced by some researchers with stage models from decades earlier.

Quickly, the Kübler-Ross Five Stages of Grief model was branded as universal knowledge among the medical community, scholars, and the public at large.

Later, Kübler-Ross clarified she never intended for the stages to be viewed as a linear progression, and that she wrote them in a way that was misunderstood. She added she meant for the stages to reveal how people with terminal illness cope with learning they are close to death, not as a reflection of how people grieve once that person has died.

In a later book Kübler-Ross coauthored, she lengthened her model to consist of all forms of loss, such as bereavement (the specific term designated for the death of someone who was significant), the end of a relationship, unemployment or loss of income, substance abuse, incarceration, infertility, and the diagnosis of disease. Thus, at best, the model is helpful for understanding grief across multiple contexts.

Major Problems with the Model

Unfortunately, there are significant problems with the Kübler-Ross model. They include the following:

Please note: For a detailed report on the problems resulting from the Kübler-Ross model from an academic perspective, please visit the citations at the bottom.

On Grief Recognition and Resolution: The TEAR Model

In an effort to replace the Kübler-Ross model with a more practical, forgiving model to help people navigate through their bereavement, therapists and other professionals have adopted the TEAR model. This is also known as the Four Tasks of Mourning and is explored in-depth by researcher J. William Worden.

T: To accept the reality of the loss.
E: To experience the pain of the loss.
A: To adjust to the new environment without the lost object.
R: To reinvest in the new reality.

Notice the paramount difference between the two models. In the 5 Stages of Grief, acceptance is at the end of the sequence which assumes the work has been completed. Conversely, in the TEAR model, acceptance is at the start of the journey. In other words, grief work can only begin once the mourning period has ended. It must come after the sympathy cards, texts and phone calls have stopped. It approaches when the bereaved individual is expected back at work or school, operating as if things are “normal” like nothing happened.

This comes after the mourning period, after when the sympathy cards, texts and phone calls stop coming. This is when the bereaved individual is expected back at work, operating as “normal” like nothing happened.

It is time we discard the widespread belief that grief is a set of prescriptive stages. We should embrace grief as an ongoing set of work, ready to be approached only once the public mourning has ceased. Acceptance is the prerequisite to face true, raw grief, and from it come recognition and resolution.

Further Reading:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375020/

https://web.archive.org/web/20100322212850/http://home.windstream.net/overbeck/grfbrf13.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375020/

About the Author, Valerie Smith, LMSW:
Valerie Smith, LMSW, CFTG, is a therapist, social worker, and certified forest therapy guide at Long Island EMDR under the supervision of our clinical director, Jamie Vollmoeller, LCSW. Valerie possesses a bachelor and master's degree in social work from Adelphi University and Fordham University, both from which she graduated summa cum laude. Valerie is also a certified forest therapy guide through the Association of Nature and Forest Therapy (ANFT), where she trained in the Rocky Mountains to master sensory-based, mindful activities through a biophilic perspective. Valerie is passionate about the health benefits of a plant-based diet as well as holistic wellness. Valerie is trained in EMDR and TF-CBT, with experience in DBT-informed skills. She focuses her treatment on adolescent girls and young women with C-PTSD and PTSD. Additionally, she helps people with life-threatening disease and their caregivers. Finally, she works alongside those experiencing grief and bereavement, especially young adults who lost one or both of their parents/guardians.

When someone survives a traumatic event, it can be beneficial to have both personal and professional support through recovery. Leaning on personal supports can be just as important as speaking with a therapist, but as a friend or family member looking to provide support, it can be difficult to find the right words to say. These conversations can be uncomfortable and difficult to navigate, but it’s important to choose your words wisely as to not further harm or re-traumatize the survivor.

In this blog post, I list a number of phrases you should avoid when speaking with trauma survivors, as well as a few things you can say in order to best support your loved one. Let’s start with the former.

What Not to Say to a Person with Trauma

“Why didn’t you say anything at that time?” 

It’s incredibly common for survivors of trauma not to disclose what they’ve been through right away. Sometimes it takes years to work up the courage and speak with someone about it. Sometimes people don’t have any memories of their trauma, and sometimes these memories come back way later on in life. 

It can also be very painful to talk about past trauma, especially when it feels like no one else can possibly understand what you’re going through. If a loved one has opened up about past trauma, don’t question why it took them as long as it did to speak up. Simply be grateful they feel comfortable enough to talk to you now, and try to support them as best as you can. 

“I know what you’re going through”

Chances are, no you don’t! Unless you went through the exact same trauma, and have the same physical and emotional responses to trauma as your loved one, you do not know what they’re going through. Everyone responds to trauma differently, and comments like this tend to come across as minimizing the effects of the trauma. For the survivor, this trauma is theirs, and while it may not be something they are proud of, they are most likely working on owning their experience and their emotions. It’s important not to take that away from them.

“Let it go” or “Get over it”

Unfortunately, these are words that many survivors have heard from someone they’re close with. It is common for survivors of trauma to be diagnosed with Post Traumatic Stress Disorder, or PTSD, and because PTSD is an invisible wound, it is often misunderstood as something that is being exaggerated. Just because you cannot see it, doesn’t mean it isn’t there. 

There is no ‘just get over it’ with trauma. Survivors do not choose to have these symptoms, and symptoms can be intrusive and incredibly debilitating. By saying things like ‘let it go’ or ‘get over it,’ you’re telling them that their feelings are too much, too dramatic, and taking too long to resolve. Each healing journey is unique, and you have no way of knowing how much work someone has already put in to get to where they are now. 

“Did that really happen?”

It is common for survivors of trauma to experience shame and guilt throughout the healing process. Many people blame themselves for what happened even if it may seem clear to you who is actually to blame in the situation. By questioning if it really happened, you’re validating and reinforcing any self-doubts the survivor has experienced over the years. This will ultimately slow the healing process, and maybe even cause your loved one to regress on their healing journey.

“It could have been worse”

This is another comment that minimizes the effects of the trauma and sends the message that the person is overreacting. What is traumatizing for one person may not be for someone else, and that is okay. Each person responds to trauma differently, but there’s absolutely no sense in comparing one trauma to another. Any survivor is hurting and trying to heal. It does not matter whose trauma was ‘worse.’ It can trigger feelings like shame and guilt, and really hinder the survivors healing journey.

“You should do/try _______”

As a loved one, the most important role you can play is being there for support, not giving advice on how to heal. Even if you’ve gone through something similar and feel like you understand, there’s no guarantee that what worked for you will work for them. And if they end up taking the advice you give but it doesn’t work out as they hoped, this can really hinder the healing process, and may even impact your relationship with your loved one. 

What Can You Say Instead?

“Do you want to talk about it?”

Oftentimes with trauma, survivors lose a sense of being in control when they went through that situation. If they feel forced to talk about it with loved ones, it can be triggering and bring up all of those old feelings of not being in control. Asking this question gives the survivor a chance to decide what they would like to do. Maybe they’re not feeling up to talking about it right now, and that’s okay. Giving them a sense of control in regards to this topic can be really helpful for their healing process. 

“I hear you”

One of the most difficult parts of the healing journey is feeling like you’re going through this alone. Sometimes being there with a listening ear is the best support you can provide your loved ones. Try practicing Active Listening. Active Listening means making a conscious effort to hear, understand, and retain the information being relayed to you. It does not always mean you have a response or advice to give. Instead, pay attention, show that you’re listening with feedback, and ask questions if there’s something you don’t fully understand. Simply saying, “I hear you” can mean the world. 

Are you a trauma survivor, or looking to better support a loved one struggling through their recovery? We can help. Give our office a call at (631) 503-1539. 

About the Author, Jennifer Tietjen, LMSW

Jennifer Tietjen is a Licensed Master Social Worker (LMSW) at Long Island EMDR and is currently receiving supervision towards her clinical license under Kristy Casper, LCSW. She helps clients by providing the support, acceptance, and empathy they need as they face challenging life experiences. Jenn is passionate about helping clients overcome past trauma and make positive change in their lives. She is trained in EMDR therapy and is currently focusing her future training and experience on women’s issues. This includes maternal health concerns such as antepartum and postpartum depression and anxiety, and reproductive health issues including infertility.

In general people see a therapist when there is a problem. This is true. Most people need some sort of problem that’s uncomfortable enough that they will take the step to begin therapy. It’s of course not comfortable opening up with a stranger and telling them all your deep darkest secrets. It takes a lot of courage and internal motivation to take that step.

Most people also think when they are starting to feel better that therapy has worked and they can now stop coming. For some people this can be true. But with most of our trauma folks, “better” simply signifies not being in constant crisis mode. Yeah, that is an awesome feeling. But because you were in constant crisis mode your therapist likely was helping you develop coping skills and maybe change your behavior a bit so you could stop the cycle.

The truth is that deep work cannot be done when you are not stable. I cannot start EMDR with a client that is chronically suicidal, self-harming and self-sabotaging. I cannot do deep work with client’s coming in with a new fire to put out every week. I can help them learn to manage the moment and self-regulate better. I can help them set boundaries so they are less overwhelmed. I can help them build up their social support so they feel less alone. All of that is still gold. It’s great life changing stuff that ends the roller coaster.

But the deeper stuff that triggers them jumping back on that roller coaster. The inner voice that feels “not good enough”, “alone”, “unlovable”, “responsible”, “guilty” etc. will end up creeping in again and those great behavior changes will likely fade away again and you're back in crisis mode.

grief counseling long island

Why Stay in Therapy

So that deep stuff. That inner child that still gets “pinged” when you get a critic at work, or your husband says “did you change the diaper genie?”, or your friend cancels plans. That work is best done when you are stable. It’s hard work. But changing that inner voice and those automated thoughts and responses is  what truly puts you in the driver's seat of your life. It is also what ends the intergenerational trauma from continuing forward with your children.

That inner voice comes out so often and so unconsciously that it perpetuates us in the cycle. The woman that struggles with self-esteem, ends up criticizing her daughter’s weight and making food comments- that cause her daughter to feel the same as her “unlovable” or that love is conditional or that my value is based on my appearance. It’s surely unintentional and likely not in any way what that mom wants for her kid. But when we don’t have full operational control of our inner voice we end up sending mixed messages to our children, our loved ones and our colleagues.

Why Low Stress Times is When Real Work Happens in Therapy

When it is smooth sailing it’s the perfect time to dive deep. There are less stressors from school, work, life problems which is why you now feel “there’s no stress. I don’t need therapy”. The lack of stress allows for you to now really dive into some deeper issues that are going to bring up some uncomfortable thoughts, memories and emotions. It is the best time to do that work because now that your daily stressors are gone you have the emotional bandwidth to add the work- and healing yourself is work.

When Do I Not Need Therapy

So now you're probably like, “Okay, Jamie. If even when I am not stressed I need therapy,  when do I not need therapy?” Valid question.

My answer is when you can easily silence that inner voice that pops up. Whether that be the voice that makes you feel responsible for others, not good enough, unlovable, damaged, guilty, or that you cannot trust your judgment. When you can easily stop playing whack-a-mole and that voice doesn’t pester you- end therapy. When you have worked through and healed that inner child- end therapy. When life is stressful and you don’t want to rip out your hair, or feel your skin is crawling- end therapy. Don’t end when there is no stress. End when you can manage your stress without being in crisis mode.

But if you are a constant crisis mode client that is finally off the rollercoaster. Please talk to your therapist about doing some deeper work. About exploring those core beliefs and truly processing the memories associated with them. We want you to feel better. Truly better and in control of your life.

Looking For A Therapist?

If you are looking for a therapist our counselors at Long Island EMDR would love to help you. What sets us apart from most therapists is that we are authentic humans. Imperfectly perfect I like to say. We are real, down to earth people. We love what we do and who we work with. We do evidenced-based work and are not afraid to challenge you when needed. Because we are down-to-earth genuine humans we truly care about our clients. Even though we will push you, we are probably some of the most compassionate, empathetic, and empowering people you will meet. Give our office a call today to be matched with a therapist who truly understands your concerns. And sleep a little better tonight knowing you took that first step.

-Jamie K Vollmoeller, LCSW

Are you struggling to get to your therapy sessions consistently?

It is common for busy people, or just everyday people, to miss therapy from time to time. Sometimes it’s a child’s game or event, double-booking for doctors appointments, or you have no energy to engage that day, there are many reasons why therapy may need to be canceled. 

You may have noticed that even when you cancel your appointment you continue to be charged, even though you were not seen. Is this normal or should you be worried?

Is It Normal to Charge For Canceled Therapy Sessions?

Yes! It is completely normal and common practice for therapists to charge the full session cost if an appointment is missed. 

If you are being charged a late cancelation fee, it is likely because you canceled your session on short notice. For us here at Long Island EMDR, we consider “short notice” anything less than 24 hours in advance. This is common practice for most therapy offices and other medical professionals . We list this policy in our intake paperwork in multiple locations and do our best to review with you during your initial session.

You may be thinking “Okay I get it you charge but why do you charge”? Below I will go over some of the main reasons why we charge for missed appointments.

Your Progress in Therapy Slows

Canceling your sessions can slow your progress to a snails pace.


The number one reason we charge is because client’s ultimately lose out when they are not showing up consistently to their appointments. Therapy is not easy- it takes commitment and hard-work. As a practice that specializes in trauma and anxiety, I can tell you avoiding therapy will only serve to maintain your current anxiety and trauma symptoms.

The truth is- the more you avoid facing your difficulties the worse your symptoms will get. We charge to motivate you to face those fears. We believe in the power of therapy and in your ability to overcome your challenges. You deserve to feel better. 

As someone who has been in therapy, I know all too well there are many reasons to cancel your session. While your reasons for canceling may be entirely valid, the truth is something can always come up. Many of our client’s late cancel because they are in a bad place emotionally, or are “too drained/anxious/overwhelmed” to deal right now. Canceling really just keeps you stuck in that cycle. Underlying your cancelation is likely a feeling that not attending is the easier option in that moment- and it may be easier in that moment- but it is not what is best for you long term.

Showing up even when it is uncomfortable allows you to work through those difficult feelings and ultimately receive the help you need to reach your goals. Therapy provides you with the support you need to feel better about your life and begin to make changes. Avoiding your sessions will only serve to make your anxiety about attending worse- not better.

Our goal is to help give you every excuse to make your mental health a priority.

We strive to make being consistent with therapy as easy as possible (which is why we always offer to switch to virtual for the day) and to make neglecting your mental health or placing it at the bottom of your priority list more difficult. This is because we believe in your ability to grow and change. Because we know you deserve to make progress towards your goals so you can start living the life you want. 

We charge a cancelation fee for the session, because we want you to come. Not just for us- but for you. Because there is a reason you chose to enter into therapy and sometimes in our busy lives we forget that our needs and priorities are important too. Consistently attending ensures you get the most out of your treatment, you are honoring your needs and feelings and you are putting yourself first! Showing up is an investment in you and your future- and we want to encourage that.

Note for Trauma Clients...

Long Island EMDR is known for trauma counseling. Clients seek us out specifically because we specialize in EMDR and are truly trauma-informed clinicians. I founded Long Island EMDR because as a trauma kid I know what the struggle is like. That one cannot simply just “stop being anxious” and that you may not fully understand why certain things trigger you- they just do.

Staff are trained continuously so you can move from past to present. A present unencumbered by the bombardment of triggers and negative self-talk that can take over your life. To help you end that constant “whack-a-mole” of thoughts popping up in your head even though you know they are not rational- which is so very emotionally draining. I believe so deeply in the work that we do and in our client’s ability to find relief- because I have seen therapy work over and over again. Our work and the results and relief we get with our wonderful, truly awe-inspiring clients is what continues to motivate me as a therapist and as the owner of Long Island EMDR.

trauma

But as trauma specialists- we also tend to push our client’s out of their comfort zones. We are not “uh huh” or “how was your week” therapists. We really dive deep into underlying issues that cause our clients to feel stuck and work through old patterns and make lasting change!

This can make wanting to come to therapy really hard at times. It can bring up unwanted memories, thoughts and feelings. It is oh so easy to just say- I don’t want to do it any more. Many client’s want to quit therapy at some point- because it often gets worse before it gets better. These feelings, thoughts, unwanted memories, flashbacks and nightmares- may very well trigger you to avoid coming to your sessions. 

Trauma kids are really great at problem-solving and avoiding pain. So your brain will very easily come up with tons of reason to cancel. They are all likely valid. What is also valid is the need for you to face your trauma and anxiety head on so your past stops replaying in your present. And to do this you need to come to therapy- consistently. 

For EMDR Clients

EMDR clients in particular. Avoiding an EMDR session on an uncompleted memory or “target” is not going to make all the thoughts and feelings that came up with that target go away. You cannot just push it back down- it’s not likely to work. Finishing processing of that target/memory, however will. The more you do it the more memories you work through. And the less true those thoughts of “I’m unlovable” “I’m not good enough” “I’m responsible” will feel. And, the less distressing the memory and its associated triggers will be. 

That is why, we are doing you a disservice by not holding you accountable when you late-cancel. Every time you cancel late and we do not charge a cancelation fee, your brain gets a wave of release. Because you successfully avoided the anxiety that week. This makes it more likely you will come up with more excuses in the future. By charging the fee, we are holding you accountable (for my neglected folx this is even more important.) And we are saying to you that your mental health matters. Hopefully this will help you to avoid the avoidance and come consistently. Research shows us consistency will truly help when you are being treated for trauma. 

It Affects Your Therapist

For our fee-for-service therapist, if you do not show and are not charged they just lost out on income for that week. If you give them notice, they may be able to move you to another time during the week and not lose out on that income, as well as ensure your consistency.   If the practice does not get paid, we cannot pay those therapists. These therapists do rely on you coming consistently to pay their bills. 

Most of our therapists are full-time salaried W-2 employees. In order to maintain full-time status they need to meet certain quotas and when clients cancel their appointment it puts those numbers in jeopardy. Though it may not affect their weekly paycheck, if they lose full-time status it does mean they lose all the benefits associated with that- including health insurance and retirement plan. While we would love to offer health insurance and other benefits to all our clinicians, the cost associated with doing so is just not possible unless they meet certain minimum standards. 

We understand that most clients are not thinking of how their cancellations affect their therapist. But when client’s consistently miss appointments it is not just employees pay that can be affected- but their lives outside of work as well. 

Late-Cancelations Affect Other Clients

As stated above, most of our clinicians are full-time. Many clinicians have little flexibility, especially after school hours to move appointments. If client’s need an additional parent session, couples session, or emergency session and we have notice you won’t be there- we can offer your time slot to those clients. When we have less than 24-hours notice there is not enough time to schedule in those clients who really could’ve used that time-slot that week.

When you just have to Cancel…

We understand there are just some times you will just need to cancel. Maybe it’s a family vacation, a night out with friends, or a big exam. That’s okay. We understand entirely.

We do however need to know in advance. As soon as you know you cannot make it- let your therapist or the front office staff know. We won’t make you feel bad or encourage you to change your plans. We will likely just offer you whatever other time-slots (if we have any) that are available that week. 

If you cancel before the 24 hour mark, we will not charge you a cancelation fee. You won’t be hurting us or other clients. And hopefully we can squeeze you in some other time so it’s not interfering with your progress either. As long as you are coming consistently, canceling when absolutely necessary is okay.

If you do cancel within less than 24 hours, we will charge you a cancelation fee of the full fee. For all the reasons I stated above. Please still let your therapist know so they do not worry about you. Hopefully we can reschedule your appointment to another time and waive the fee. But this is not a guarantee as most of our therapists have very full schedules.

Looking for a Therapist?

Our counselors at Long Island EMDR would love to help you on your journey. We have clinicians with a variety of specialties including trauma, EMDR, TF-CBT, LGBTQIA+ issues, grief & loss, teen counseling, caregiver issues, anxiety & depression. Contact our office today to schedule with a therapist and take the first step towards wellness. 

Sending Love & Light,

-Jamie Vollmoeller, LCSW

What is C-PTSD? How is it Similar and Different from Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD) are both neurobiological disorders that occur when someone experiences or witnesses a traumatic event. Examples include, but are not limited to, war or combat, natural disasters, physical or sexual assaults, and life-threatening accidents.

Almost all of us associate PTSD with veterans. We understand combat is gruesome on the body and devastating to the psyche. We realize war is hell, if only we look at the faces of our veterans when they return. We know, even without words, that they went through something far beyond the scope of normal human experience. In fact, generations before the term “post-traumatic stress disorder” became public knowledge, and added by the American Psychiatric Association to the Diagnostic and Statistical Manuel of Mental Disorders in the 1980s, PTSD was known by other names: war neurosis, shell shock, soldier’s heart, or combat fatigue. Furthermore, much of the research, advocacy, awareness, and treatment options for PTSD have been through means such as the U.S. Department of Veterans Affairs. Thus, it makes sense we as a collective society to visualize a soldier in battle when we think of PTSD.

However, across the general population and in terms of numbers, PTSD is most prevalent in people who have experienced dangerous, life-altering events. It seems to be most frequent in survivors of sexual assault or those who went through or witnessed violent car accidents, both which involve powerlessness, danger, and terror. Furthermore, PTSD can occur in populations that often are forgotten to be traumatic, such as ICU stays.

It is believed most people will experience at least one traumatic event in their lives, and a fourth will develop PTSD. It is not known how many people live with C-PTSD.

Symptoms of PTSD

People who suffer from trauma may feel its impact for days; this is called acute trauma. If the symptoms continue for weeks or longer, and if they are disruptive to daily living, that is suggestive of PTSD.

There are three types of PTSD symptoms:
Hyperarousal symptoms. People with PTSD may have sense-of-threat symptoms, as if they are on edge and hypervigilant of their environment. They can have a startled response such as jumpiness.

Re-experiencing symptoms. Nightmares and flashbacks are the hallmark symptoms of PTSD. The individual may “go through” the trauma again via memories, via sensory experiences and emotions. The individual may feel the same smells, sights, sounds of the trauma.

Avoidance symptoms. Those living with PTSD will participate in avoidance symptoms, as in avoiding triggers associated with the trauma. This is broad, and can include places, situations, people, or events (i.e., holidays). They may also attempt to drown the symptoms through self-medicating with alcohol or other substances.

What is Complex Post-Traumatic Stress Disorder?

C-PTSD is a messier, multilayered version of PTSD which involves prolonged or chronic attacks on an individual’s sense of safety, self-worth, and integrity. This is dissimilar to PTSD, which is the result of one traumatic event. The ongoing maltreatment causes a multitude of additional symptoms, which shape neuropsychological development such as personality.

C-PTSD results from situations of chronic powerlessness and a lack of control, such as long-standing domestic violence (whether experienced or witnessed), sex trafficking, or child maltreatment. However, it is most common in those who were subjected to child abuse or neglect beginning in the earliest formative years, especially if the harm is by a caregiver or other significant adult, and there is a lack of hope for escape or that the situation can otherwise improve. Also, multiple traumas increase the risk of developing C-PTSD too.

Symptoms of C-PTSD

People with C-PTSD have compounded symptoms of both PTSD and those from other mental health disorders. These may include the following:

Psychosomatic issues: Psychosomatic issues are physical issues without a medical explanation, caused or worsened by a psychological reason such as stress. It is common for people with C-PTSD to have vague physical symptoms such as dizziness, chest pains, abdominal aches, and headaches.

Emotional flashbacks: A flashback is a vivid, intense experience in which a person will relive some parts of a trauma or feel as if it is happening in the present. Stereotypically, people tend to think of the war veteran who is having a “movie-like” flashback in which the event unfolds again in its entirety. However, a flashback does not need to be so extreme – and usually they are not.

People with C-PTSD are likelier to experience what is called an emotional flashback – that is, the emotions experienced during the trauma, such as shame or fear. Such individuals may react to these events in the present, unaware they are having a flashback.

Difficulty regulating emotions: Those with C-PTSD may experience sharp, vivid emotions which can be inappropriate for the situation. These rapid shifts in mood can be misdiagnosed as bipolar disorder or borderline personality disorder, which can have similar features but are not the same.

Flat affect: People with C-PTSD may also have a flat affect, meaning they appear numb, somber, or emotionless to others. This body language can be misinterpreted by others, making people think the individual is feeling a certain way or is aloof. In truth, the person may have a rich, complex inner world of their emotions and be feeling very differently than how they are expressing themselves.

There are several reasons for a flat affect. One powerful reason is because the individual may not have witnessed emotional expression in their formative years, thus in turn they have been sharpened to be “flat” as an adult. To explain it plainly, imagine a primary caregiver not smiling at their baby. The baby mimics and responds to the caregiver by also not smiling. This is sharpening the baby to respond such a way going forward.

A lack of emotional vocabulary: Finally, individuals with C-PTSD may have difficulty with articulating their emotions or they may not understand what they feel; that is, there is an absence of an emotional vocabulary. They may struggle in therapy when asked “what are you feeling?” and respond with “I don’t know” or they may describe a physiological feeling instead (i.e., tiredness, nausea). This is because in the context of prolonged trauma they had to adapt to shutting down their emotions to survive. For example, they may have been programmed in their earliest years to think “emotions are bad” because they were consistently invalidated or punished for emotional expression by their caregivers.

Dissociation: Dissociation happens to everyone. Dissociation is a sensation of feeling disconnected from oneself and the world through a sensory experience, thought, sense of self, or time. A person who dissociates may feel depersonalization (detached from their body) or derealization (feeling as if their surroundings are unreal). And at one time or another, all of us have dissociated. Getting lost in a daydream, forgetting the details of a car drive, or spacing out during a boring class lecture are all examples of dissociation.

When applied to trauma, dissociation is an innate coping mechanism. It is a protective action taken by the mind to let an individual survive a traumatic experience. At the time of the event, dissociation is beneficial, especially for children as they often lack insight and more sophisticated coping skills. However, the downside of dissociation is that when someone has dissociation and is at risk of developing C-PTSD or another trauma-related disorder, the dissociation does not resolve the trauma. In adulthood, the effects of dissociation can negate the ability to trust, form and maintain healthy relationships, and prioritize self-care. Through the phenomenon of mind-body separation, individuals may develop self-destructive behaviors such as ones that keep them dissociated (“I can’t tell when I’m feeling hungry, so I eat less than I should”) or ones to make them dissociate (“I drink alcohol to numb myself so I don’t have to feel my despair”).

(Dissociation is a complicated phenomenon which cannot be fully explained in a few paragraphs. The article writer will make a detailed blog entry dedicated solely to dissociation in the future.)

Negative core beliefs: Individuals with C-PTSD may have the core belief “I am not safe” or “the world is unsafe.” Alternatively, they may have other core beliefs (“I am unlovable” or “I am not worthy of respect”, for example). These core beliefs are deeply ingrained, at the pool of their identities, which can mean the individual is unaware they even carry such beliefs until they develop more insight.

Relationship difficulties: Individuals with C-PTSD can struggle with developing and maintaining healthy relationships. Such individuals struggle with feeling able to trust others due to their traumatic histories; thus, they may isolate themselves or feel intensely uncomfortable with “opening up” to others. Or they may respond inappropriately in a social situation. Unfortunately, these factors only enhance their risk of disapproval or misunderstanding by others, which makes them more susceptible to social isolation or ridicule.

Additionally, people with C-PTSD are more susceptible to entering and remaining in abusive relationships – especially those who already experienced abuse. 

Treatment for C-PTSD

C-PTSD is a treatable condition. However, clients (patients) should be cautious when selecting their therapist. The treatment of complex trauma is a specialty, and not all therapists have the knowledge, skills, or experience to adequately support those who have C-PTSD. Thus, it is encouraged to “screen” the therapist during the consultation session by asking for their background in treating C-PTSD. Much like we may make thoughtful, careful choices about our medical doctors, the same should be done for therapists too!

Ask the therapist about their intervention styles (treatment approaches) as well.

The following treatments are frequently employed for C-PTSD treatment:

There is hope for healing from complex post-traumatic stress disorder!

Looking For a Therapist?

All of our counselors here at Long Island EMDR specialize in trauma work. We have a variety of sub-specialities within that including sexual assault, domestic violence, infertility, childhood abuse/neglect, loss of a loved one and bullying. Contact our office today to schedule with a therapist who meets your needs and start living the in the present.

Citations/further information:

Websites:
American Psychological Association (APA) – PTSD Treatments
https://www.apa.org/ptsd-guideline/treatments

CPTSD Foundation: https://cptsdfoundation.org

Healing From Complex Trauma & PTSD/CPTSD

(Complex) Post Traumatic Stress Disorder

https://www.healingfromcomplextraumaandptsd.com

Mind – Complex post-traumatic stress disorder (complex PTSD)
https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/complex-ptsd

U.S. Department of Veterans Affairs – National Center for PTSDhttps://www.ptsd.va.gov/index.asp

WebMD – What to Know About Complex PTSD and Its Symptoms
https://www.webmd.com/mental-health/what-to-know-complex-ptsd-symptoms


Books:
Pete Walker – Complex PTSD: From Surviving to Thriving

Arielle Schwartz – The Complex PTSD Workbook

Bessel van der Kolk – The Body Keeps the Score

-Valerie Smith, LMSW

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